Regular paper
Baseline characteristics, management practices, and in-hospital outcomes of patients hospitalized with acute coronary syndromes in the Global Registry of Acute Coronary Events (GRACE)*,

https://doi.org/10.1016/S0002-9149(02)02489-XGet rights and content

Abstract

Acute coronary syndrome (ACS) represents a heterogenous spectrum of conditions. The Global Registry of Acute Coronary Events (GRACE) describes the epidemiology, management, and outcomes of patients with ACS. Data were collected from 11,543 patients enrolled in 14 countries. Of these patients, 30% had ST-segment elevation myocardial infarction (STEMI), 25% had non–ST-segment elevation myocardial infarction (NSTEMI), 38% had unstable angina pectoris, and 7% had other cardiac or noncardiac diagnoses. Over half of these patients (53%) were ≥65 years old. Reperfusion therapy was used in 62% of patients with STEMI. Percutaneous coronary intervention was performed in 40% of these subjects during the index admission. Intravenous glycoprotein IIb/IIIa blockers were used in 23%, 20%, and 7% of patients with STEMI, NSTEMI, and unstable angina, respectively (STEMI vs NSTEMI, p = 0.0018, and for either group vs unstable angina, p <0.001). Coronary artery bypass grafting was performed in 4%, 10%, and 5% of patients, respectively (p <0.0001). Hospital case fatality rates were markedly different among patients with STEMI, NSTEMI, and unstable angina (7%, 6%, and 3%, respectively; STEMI vs NSTEMI, p = 0.0459, and for either group vs unstable angina, p <0.001). Congestive heart failure complicated the hospital course in 18%, 18%, and 10% of the patients, respectively (p <0.0001), and recurrent angina with ST-segment changes occurred before discharge in 10%, 10%, and 9% of patients, respectively (p = 0.2644). GRACE provides a detailed and comprehensive global description of the spectrum of patients with ACS.

Section snippets

Methods

Full details of the GRACE rationale and methods have been previously published1 and are outlined briefly as follows. A total of 95 hospitals organized into 18 clusters in 14 countries in North and South America, Europe, Australia, and New Zealand are currently collaborating in GRACE. Clusters were chosen based on local demographic characteristics and hospital facilities to ensure a representative sample of patients with ACS from each country and hospital systems of different sizes and treatment

Results

Enrollment in GRACE started in April 1999 and involved 95 institutions (Table 1). At admission, patients were assigned a working diagnosis of myocardial infarction, unstable angina, rule-out myocardial infarction, or chest pain. The present study includes a total of 11,543 patients enrolled by the end of December 31, 2000. Using the prespecified diagnostic criteria described previously, cases were subsequently divided into those with STEMI (30%), NSTEMI (25%), unstable angina (38%), or other

Discussion

The management of ACS has been well defined by clinical trials and summarized in reviews4, 5 and guidelines.6, 7, 8, 9 However, “real life” patient populations sometimes differ markedly from those in clinical trials.10 In addition, there is considerable heterogeneity in patient management practices.11 Therefore, large-scale observational data sets, such as GRACE, are important to complement the information obtained via randomized clinical trials.

One potential value of registry data is the

References (19)

  • Rationale and design of the GRACE (Global Registry of Acute Coronary Events) projecta multinational registry of patients hospitalized with acute coronary syndromes

    Am Heart J

    (2001)
  • Objectives and design

    Int J Epidemiol

    (1989)
  • H. Tunstall-Pedoe et al.

    Myocardial infarction and coronary deaths in the World Health Organization MONICA Project. Registration procedures, event rates and case-fatality rates in 38 populations from 21 countries in four continents

    Circulation

    (1994)
  • P. Théroux et al.

    Acute coronary syndromes. Unstable angina and non-Q-wave myocardial infarction

    Circulation

    (1998)
  • Y. Yeghiazarians et al.

    Unstable angina pectoris

    N Engl J Med

    (2000)
  • Acute myocardial infarction: pre-hospital and in-hospital management

    Eur Heart J

    (1996)
  • Ryan TJ, Antman EM, Brooks NH, Califf RM, Hillis LD, Hiratzka LF, Rapaport E, Riegel B, Russell RO, Smith EE III, et...
  • M.E. Bertrand et al.

    Management of acute coronary syndromes without persistent ST segment elevationrecommendations of the Task Force of the European Society of Cardiology

    Eur Heart J

    (2000)
  • E. Braunwald et al.

    ACC/AHA guidelines for the management of patients with unstable angina and non-ST-segment elevation myocardial infarction. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on the Management of Patients With Unstable Angina)

    Circulation

    (2000)
There are more references available in the full text version of this article.

Cited by (0)

GRACE is supported by an unrestricted educational grant from Aventis Pharma, Bridgewater, New Jersey.

*

Further information about the project, along with a complete list of the study participants, can be found at www.outcomes.org/grace.

View full text